Recent studies recommend that everyone, beginning at the age of adolescent, should have their cholesterol tested to check if they are at risk for heart disease. It is especially important in all young persons who have a family history of heart disease. Those with elevated blood cholesterol and other lipids should substantially lower their consumption of saturated fat and cholesterol as previously discussed in last month’s issue of the Singapore American Newsletter. This article addresses those people that despite dietary changes, still have high cholesterol and therefore need to take medication.

As mentioned earlier, drug therapy should be considered only if maximal diet, weight reduction, and exercise efforts do not bring cholesterol levels to acceptable levels. The objective of medication is to reduced the LDL-C (the so called “bad cholesterol”) to less than 160 mg/dl. However, people with heart disease or risk factors for heart disease, should aim to have their LDL-C level below 130 mg/dl.

Until recently, first-choice drugs to lower cholesterol have been: 1) the bile acid sequestrant resins, such as cholestyramine (Questran) and colestipol, and 2) nicotinic acid. They have been found to be safe and effective in lowering cholesterol levels. However, they may be associated with many unpleasant side effects. The bile acid sequestrant resins can cause constipation, abdominal discomfort, nausea bloating, heartburn, belching, flatulence and occasionally vomiting. These effects will often diminish with continued use of the medication. These resins may also interfere with absorption of other medications. Therefore, all other medications should be taken either one hour before or four hours after taking this cholesterol lowering drug.

Nicotinic acid is actually a water-soluble vitamin. Side effects at higher doses are frequent and include flushing, generalized itching, rash, dizziness, nausea, decrease appetite and low blood pressure. This medication should not be taken by those who have gout, stomach ulcers, inflammatory bowel disorders or heart arrhythmias.

The newest class of cholesterol-lowering drugs are very potent. They work by affecting the body’s ability to make cholesterol. This class of drugs include lovastatin (Mevacor), simvastatin (Zocor) and pravastatin (Pravachol). They are increasingly being used as the initial drug treatment to reduce cholesterol levels. Side effects are usually mild and transient, and include muscle aches and elevation of liver blood test. When starting these drugs, liver blood test should be checked in six to eight weeks, and thereafter as directed by your doctor. Recent favorable studies have shown that simvastatin actually slows the narrowing and clogging of arteries, an ageing process called atherosclerosis.

Finally, the fibric acid derivatives are a class of medication used to lower cholesterol and/or triglycerides. Side effects include bloating, abdominal discomfort, diarrhea, nausea and occasionally rashes. Similar to several other cholesterol lowering medications, liver blood tests should be checked six to eight weeks after starting the medication.

Fish oils are highly unsaturated omega-3 fatty acids present in cold water fish. They ared commercially available in capsules without a prescription. They can decrease triglycerides and cause small decreases (or sometimes) increases in LDL cholesterol. No comprehensive studies are available that compare the effectiveness and safety of fish oil with other lip-lowering drugs. Interest in fish oils When taking cholesterol lowering medication, it is important tha your doctor monitor your treatmlent on a regular basis. The long term goal of treatment is to lower cholesterol to acceptable levels and thereby reduce the chance of heart disease. Equally important is quality of life, and therefore side effects to these drugs must be minimized.